On a rainy Thursday morning this October, police blockades, fire trucks and news vans lined Cedar Street outside Yale-New Haven Hospital. A doctoral student, returning from research abroad in Liberia, had been hospitalized with a slight fever — a possible precursor to Ebola. The individual was quarantined, and the relevant authorities were informed. It was confirmed later that afternoon that there was no Ebola, just some more innocuous malady. But if the scare itself was a false alarm, the day’s events suggested something about the way people respond to Ebola and to other threats like it.
“We have extreme fear without extreme compassion,” says Kristina Talbert-Slagle, an epidemiologist and officer at the Global Health Institute, of the public reaction to Ebola.
It seems that apart from its actual, viscerally gruesome effects, the disease infects us in other ways. Fear itself becomes viral through what Talbert-Slagle calls a “withdrawal from our natural urge to be compassionate and loving to those suffering.”
Nowhere is that more apparent than on the ground in West Africa, at the epidemic’s epicenter, where the presence of the disease and of those trying to fight has strained the bonds of society.
“Conspiracy theories are everywhere,” says Jamie Childs, an Ebola expert and lecturer at the Yale School of Public Health. He adds that Ebola has undermined traditional behaviors and led to social upheaval in affected areas, making those in need suspicious of foreign aid.
Health workers trying to prevent the disease’s spread have been attacked, abducted and killed. In a UK Independent article from September, Meredith Stakem, a health and nutrition adviser for Catholic Relief Services, noted that the disease “is so new to this part of the world and so terrifyingly lethal that many people fear all outsiders associated with Ebola, even if they are coming to help.”
She added that many people in affected communities may not understand the biology of disease transmission, which makes it difficult to adapt their behavior to the circumstances. Measures seen by public health organizations as containment of the disease — individual quarantine, bans on border crossing and public congregation — are seen by residents as an imposition. Foreign aid workers often meet resistance when they try to intervene in local burial practices, which allow the disease to spread because they involved prolonged contact with corpses.
“It’s a funny clash between cultures, value and morality,” says William Summers, a Yale virologist and history of medicine professor. “Historically,” he explains, “public health interventions have been strained because people do not trust their governments, often times justifiably. So, you need to reach out to other sources to see results.”
Those other sources, Summers thinks, are local cultural leaders — people who can convince scared locals to cooperate with foreign workers. Otherwise, the spread of fear can undermine efforts to stop the spread of the disease.
But even thousands of miles away from the regions worst hit, the fear Ebola incites can be contagious — something University President Peter Salovey acknowledged when he sent a campus-wide email the morning of the scare. Salovey concluded his email with the following: “I feel that I should directly address the question of why our Public Health students — or why anyone affiliated with Yale — would even consider traveling to these dangerous parts of the world.”
He went on to explain that Yale’s reserves of expertise and its tradition of service left the University and its students obligated to put their abilities to their “highest, best use.”
If his email is any indication, Salovey detected a sense on campus that Ebola was to be avoided at all costs. At Yale and elsewhere, such fears manifest themselves in various ways, one being the failure of incessant media coverage to turn Ebola into a social cause.
A New York Times article from Oct. 20 noted the lack of American public donations to fight Ebola as compared to other international disasters of the last decade, such as the 2004 tsunami in the Indian Ocean, the 2011 nuclear disaster in Japan and the 2010 earthquake in Haiti. Political attack ads have often referenced the disease as a foreign policy failure rather than a humanitarian crisis. Indeed, Ebola only entered the American consciousness once it started affecting Americans.
Despite the epidemic starting in January of 2014, and despite the humanitarian organization Doctors without Borders calling for increased aid that March, coverage of Ebola in the American media began to accelerate when an American doctor and a missionary working abroad both contracted the virus in early August.
Christopher Lockwood, a Yale World Fellow and an operations manager for Doctors Without Borders, says his organization had to set up multiple training centers last March because there were not enough doctors prepared to treat Ebola’s victims.
“We had to start turning some Ebola patients away last spring, because they weren’t sick enough, and we were already at capacity. So the worldwide response, from that perspective, was quite delayed.”
That delay might stem from the unvoiced distinction Americans make between ourselves and the foreboding “other world,” where we think deadly diseases are just a part of everyday life. But such distinctions can undermine our empathy — and as it turns out, this has appeared many times before.
“In the first epidemic of cholera in the 1800s, we had this concept of American exceptionalism — our society was different from Europe, so we couldn’t get the same disease,” says Summers. “By the time the third epidemic rolled around,” he laughs, “we changed our viewpoint, but in many ways our view of Africa is still stuck in a Joseph Conrad-esque ‘Heart of Darkness’ world.”
According to Talbert-Slagle, that distinction between “us” and “them” is part of our lack of compassion. The virus turns our natural affection for each other into fear.
“Our irrational protection against this fear,” she says, “is to put up these artificial boundaries.”
But, she continues, such boundaries are only imagined. “As a species, we are 99.9% genetically identical to each other,” laughs Talbert-Slagle, “and so this distinction between self and other, which is so often talked about in both society and in science, is only applicable to 0.01%.” But we nonetheless think of ourselves as somehow different from Ebola’s victims.
In this and other ways, American public sentiment regarding Ebola is similar to the public’s first response to AIDS in the 1980s.
The first five cases of HIV in the United States occurred in 1981. The disease was named in 1983. But it was only in 1987 that President Reagan even mentioned the word “AIDS” in a sentence.
And many misconceptions surrounding the transmission and symptoms of HIV have now resurfaced in the public discourse about Ebola. In the 1980s, a lack of media coverage contributed to public confusion, but today, the opposite has occurred: Since being picked up in August, Ebola has featured prominently in American media.
What makes something like Ebola or Mad Cow Disease, which caused a similar stir a few years ago, so public? According to Summers, fear of the unknown has fueled the media frenzy.
“We have rapid tests, we know about the virus” he says, “yet we still view it as something entirely foreign.”
Julia Rozanova, a postdoctoral associate of sociology at the School of Medicine who studies media portrayals of chronic diseases, agrees. She says the nature of the disease has encouraged the media to focus on it.
Media outlets, Rozanova says, focus on “sensational” stories likely to draw a large audience. Ebola, with its overwhelming pace of infection, “evolves so spectacularly and violently in the human body that it’s chosen as a good fit for ‘big news’ and framed as such in mass media.”
The result is coverage that, to many involved in fighting Ebola, seems more accusatory than accurate. “The question is always, ‘What went wrong?”’ or ‘What could have gone better?’” says Summers. “In fact, healthcare and governmental organizations are doing quite a good job with the response.”
Increasingly, Summers adds, organizations like the CDC and hospitals are coming under attack for what many see as a delayed or underwhelming response to an impending threat. But Summers says this is a totally wrong way to understand the role of the CDC.
“The CDC is an advisory organization, not an operational one. They do not have the right to go into states and dictate their responses — in fact, they don’t usually even give guidelines on how to respond unless specifically asked.” Citing examples like this, Summers says that the majority of media coverage cannot, in fact, be termed information. Rather, he says, the media’s repeated assumption that something is being kept from the public undermines actual experts on the subject and leads people to blame them rather than listen to them.”
The real information out there, Summers says, is quite consistent: If you don’t have symptoms, then you are not contagious.
But this hasn’t stopped people from being often unjustifiably suspicious of those around them. A clinician at Yale-New Haven Hospital, who spoke on the condition of anonymity, mentioned that his African-American colleague went home early on the day of the scare because many of his patients called to mysteriously cancel their appointments. The clinician’s colleague thought his patients might associate him, being black, with the predominantly black victims of Ebola.
There is evidence that confusion over the correct response to the outbreak exists even at the highest levels. “There is little uniformity to countries’ responses,” says Childs, “and often, whatever decisions are made are quickly reversed.”
Rozanova says that a better way to process Ebola-related news is to understand that there is no such thing as “the right information.”
“All information is produced by somebody who has a specific intent,” she says. “It’s just that the intents of people or groups producing information can be different.”
But Rozanova’s study of media portrayal indicates that audiences can, and indeed do, identify and account for the intent behind media portrayals. In other words, it’s up to the public to resist media hysteria.
But this is difficult, because as Talbert-Slagle phrases it, Ebola brings to light the “yin and yang of fear.”
On one hand, we unite to aid those suffering: witness the public health workers, the doctors, the missionaries and Silicon Valley millionaires who have chosen to donate to the CDC’s research efforts.
On the other hand, we are scared, and this leads us to shun outsiders.
But we should not let this emotion determine our response to the disease. Indeed, says Childs, there is a chance that we are shooting ourselves in the foot by quarantining health workers, who are often volunteers, on minimal suspicion.
Referring to New York and New Jersey’s recently enacted 21-day quarantine on asymptomatic health workers returning from affected areas, Childs says. “For somebody going to volunteer in these places, knowing that there is a high chance of coming back and being out of work for almost a whole month is a huge deterrent.”
To some, the quarantines seem misinformed, like many aspects of our response to Ebola. According to Lockwood, they are “political, rather than a medical, evidence-based judgment.”
And according to Summers, the lack of an Ebola vaccine similarly results from our priorities being out of order. A prototype vaccine has existed for 15 years, he says, but we haven’t developed it because there is no money to be made. That, he says, is the lesson to be learned here: When we let self-interest dictate our response to others’ misfortune, no one benefits.